Health Care – The Coming of the Toads

Only the Lonely

Dr. Vivek H. Murthy, the United States Surgeon General, has declared loneliness a national health crisis. It’s as if the Pope questioned the doctrine of transubstantiation. The pioneer spirit feels a needle puncturing its balloon. It reads like a headline in the Onion, a bad joke.

Loneliness is epidemic, Murthy says, crosses and affects all sociodemographic boundaries and classes. There are no distinctions. The loneliness virus can infect anyone. Murthy recently traveled around the country, and everywhere he went, he talked to folks who questioned their self-worth, their connections to family and friends, the value of their very existence.

We might jump to an explanation, our personal predispositions and assumptions slipping into gear. Apparently, a trip to Walmart to stock up on beer and chips for the big game on TV is not enough to fill the void, but then neither is driving to Rodeo Drive in your Rolls Royce for a new dress. In church, one feels pewed-in, and the kiss of peace lacks true touch. And the more Mega, Meta, or MAGA one gets, the worse the symptoms of loneliness.

Loneliness looks and feels much like depression and anxiety, a lost in the world feeling, made worse by the vast numbers of people surrounding, none of whom one might talk to. One’s old drinking buddy is on the wagon. One’s ex (spouse, friend, religion, school, job) is full of the need for schadenfreude gotchas. One’s pronoun choices come up short. One feels a need to be a verb, as Buckminster Fuller said, only to have one’s grammar or usage corrected. And in one’s own home, one might feel like a direct object, put upon by a subject, or a noun without a verb.

I’m sorry I don’t have a cure, but Murthy has proposed a plan. Might be worth Googling (or see link below). Meantime, I’m reminded of the old Roy Orbison song:

Only the lonely
Know the way I feel tonight
Only the lonely
Know this feeling ain’t right

https://www.hhs.gov/surgeongeneral/priorities/connection/index.html

Pick up and Delivery

Quickly but gently Pinch said and the three of us downloaded a dozen boxes from the plane into the yellow Hummer. The work done Pinch and I stood between the Hummer and the helicopter and watched the airplane take off and swoop west and over the hills. I was to drive back to the schoolhouse where we would unload the boxes. Pinch would follow me from the air in the helicopter. What about Sylvie, I asked. What about her? She said you’d be a good delivery man. The boxes were all the same, the size of a case of wine, and weighed something like six bottles of wine each, I guessed, but they must have been packed exceptionally well because I didn’t hear any glass as we shifted them from the plane to the Hummer. Unmarked, tightly taped, thick cardboard boxes. Was there a black market for wine? I asked myself. I was on a country road, the helicopter visible, crisscrossing above me, but when the road narrowed and curved and passed under a canopy of trees growing near the river I pulled over and cleanly cut open one of the boxes. Bottles, labels taped to each with handwritten numbers and letters and dates, not commercial labels, but coding that might have been winery production information. I removed one bottle and stuck it under my seat and pulled back onto the road and saw the helicopter again above and ahead of me. At Pinch’s place I pulled into the backyard and he was waiting and we carried the boxes into the covered back porch and he told me to put the bottle I’d taken back in its box. It’s not wine, he said. It’s medicine. You don’t want to drink it. Or talk about it.

“Pick up and Delivery” is episode 75 of Inventories, a Novel in Progress in Serial Format at The Coming of the Toads.

Sylvie’s Dream of Counterpoise

Desultory. Defunct. Deconstruction. Debunk. Defunct. Deride. Decide. Depot Bay.

Sylvie dreamt an invisible wave of counterpoise forced all mortals to wear masks covering nose and mouth. Thus individual identity, what Freud called the id, was lost, and people would have to look into one another’s eyes when speaking and could only speak truth. Those refusing to wear a mask would be called liars and deniers and would be subject to debunking. Society would be detoxed of retail. Skilled jobs would return, though no one would be forced to work, and those who chose to work would not commute but work from home in building and making useful tools and items and providing useful services for daily life. One person might make beer, another shoes, another tiny houses. Another would keep the books. A livable wage would be guaranteed for every citizen of every country. The wave of counterpoise would cause disruption through widespread removals and reversals, humans moving down and away from commercialized statuses. Some would move literally underground. Already people were reinhabiting the Seattle Underground. Others were moving onto beaches or into the woods or turning abandoned malls into suburban campgrounds. Society would be deconstructed. Education would be deschooled. Police systems would be demilitarized and decentralized. Mortals would lose interest in their personal DNA and the social status of individual ancestry. It wouldn’t signify where one came from. The elderly would not be forced into retirement, but would assist with the care and teaching of the young, in growing community gardens, in making music, in writing and reading. Health care would be available to all and its underlying purpose would be health and not medicine. Cities would grow quieter, people moving around less, walking and biking, riding open air busses, trams, and light rail. Many things people had long taken for granted would disappear. Simplicity, simplicity, simplicity would return. As would civil disobedience. People would be responsible for their own entertainment. When I asked Sylvie how this counterpose, as she called it, was to come about, she said she did not know, but had awakened too soon. At the end of her dream, she was swimming with the whales off Depot Bay.

“Sylvie’s Dream of Counterpoise”
is episode 12 of
Ball Lightning
a Novel in Progress
in Serial Format at The Coming of the Toads.
(Click link for continuous, one page view of all episodes.)

Roofbug

– There’s a BIG BUG on the ROOF!
– Keep calm. It will go away.”

Banana Yellow Sunrise

About fell asleep waiting on doctor to come
under beguiling wall poster of limbic system.

“I’m going to give you three words, and I’ll ask
for them back before we’re done.”

I repeated each word after her:
yellow – yellow; banana – banana;

sunrise – sunrise. Then she moved
for the cuff and I rolled up my sleeve

and she asked how Susan was doing.
Sunsee, sunsaw, I thought about

Buckminster Fuller’s neologisms,
and also considered the possibility

the doctor had given me not three
but four words, sunrise compound,

two words in one meaning. There
was a time I might have discussed

this with her, but no more. I felt
my arm swell as the cuff tightened.

Had I fallen in the last year? No,
not that I could recall, small smile.

Trying to keep her three words
top of mind, I inverted them:

banana yellow sunshine, locking
them together as a descriptive

phrase, cleverly reducing work
from three chores to one.

How many beers did I drink
in a week’s time? Finally, she asked

for the three words back,
catching me off guard.

She sat quite close to me,
her face to mine, and I saw

her nonplussed, and I knew
something was wrong.

As I left her office to go down
to the lab to leave some blood,

I thought about the difference
between sunrise and sunshine,

sunshine like adding a 7th
to a sunrise triad.

Cyberpunk

Round ears curl silver coils of sounds,
across nose stands glass bridge in worm-fog,
always under construction.

Every sense a degree, and digression, and distraction.

This is technology:
rubber sneakers, cotton threads,
titanium screw implants capped
with fool’s gold.

Then that hardened heart
lumbering loose without nails
full of sloth a snail’s shake
ebbs & flows fickling & flicking
comes & goes riding the tides
like a pickle on smooth ocean
swells rising then falling
oily muscle lifting and dropping
off to sleep, surly salty
heart pickled in hope chest,
just like a human heart.

Scamble and Cramble: Two Hep Cats! The Poetry Episode

A new Scamble and Cramble episode has been posted to the Comics page! And, meantime, regular readers of The Coming of the Toads may notice a new format now in the works. Please browse around and let me know what you like or not of the new template.

How to Fix a Broken Heart

img_20160911_131835 It is easy to get lost in the hospital. From the main artery grow several asymmetrical wings rising to varying heights. When one of the two main artery elevators opens, the landing pad presents an unexpected reception area, depending onto which floor you alight.

I had thought room 3217 afforded a view of the Hope and Healing Garden, but over the week, as I wandered about on visit breaks, I realized it wasn’t the garden I had seen on the hospital floor-map, but just a breezeway between wings, an alley, really, of a horizontal line of maple trees rising vertically above a trapezoidal space created by three wings. One of the nurses said that when she started at the hospital, those trees were only a few feet tall. I was reminded of the William Carlos Williams poem,

Between Walls

the back wings
of the

hospital where
nothing

will grow lie
cinders

in which shine
the broken

pieces of a green
bottle

Williams found hope and healing where he could, and here between walls grow beds of dark green, glossy ivy, out of which grow the spindly maples.

On another walk, taking another breath break, I discovered the Meditation Garden, an open air courtyard enclosed by hospital walls. The Meditation Garden was quiet and relaxing, with a variety of benches and tables for sitting and if lucky, meditation. But I thought of the little book “How to Relax,” by the Vietnamese monk Thich Nhat Hanh. Meditation is not what you might think; it’s more about what you don’t think. And, Hanh says, you don’t need a special garden, mat, or incense to meditate. You just need to relax, and breathe. I get that, but still, the Meditation Garden is a good hospital getaway space.

There were other places to chill out: outside on the grounds; the cafeteria; the Pavilion lobby was very pleasant; the LivingWell Bistro; the chapel. I liked the chapel, but was a bit put off by the giant mural of a long, blond hair and blue eyed Jesus. Susan has blue eyes, and her hair was once beach blond. I think Jesus’s hair must surely be grey by now, if he hasn’t pulled it all out.

Another day, I found the Hope and Healing Garden, but I couldn’t get in. I saw a tree growing over a circular brick wall, and I tried to find a way into the garden, which I could just barely see through a door window across an aisle and though another door window.

As I was writing that last sentence, in my pocket notebook, sitting comfortably in the digs of a spiffy waiting room lobby area outside the vegan LivingWell Bistro, an immense amount of new and fascinating technology was wandering Wi-Fi-like through and around patients, taking blood, artery, vein, and heart pictures. I had a glimpse of the imaging room from the hall just before I came out to sit here to wait: clean and sparkly, the four imaging technicians in starched blue scrubs, and the cardiologist, an ancient oracle, about to reveal obscure things that live behind screens.

On a slide show screen on the wall in the lobby, across from the waiting area couches, I could see photos of the Hope and Healing Garden, and reading the slides, discovered the garden has limited access. It’s for mental health patients.

I’ve been waiting almost two hours now. The oracle should be coming through the big set of automatic doors soon.

It’s hard to fix something that is a work in progress. The heart is a jalopy, constantly under repair; a fishing barge rising and falling with the tides, taking on water; a yo-yo with a broken string, a bicycle with a jumped chain, a stew of recycled images.

The gods make contact with the humans through the oracles. The people want miracles, but the gods grow jealous of the oracles and humans and make mistakes. What a strange way for a god to behave.

The modern god likes to hide. Like Tolstoy said, he sees and knows but waits, while humans, as Gertrude Stein remarked, inside, are always the same age. But I’m not sure about that. As Cornel West said, time is real, and we can’t break-dance at 70 like we could at 17. Or surf. But Isaiah said:

He giveth power to the faint; and to them that have no might he increaseth strength. Even the youths shall faint and be weary, and the young men shall utterly fall: But they that wait upon the Lord shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint. (40 KJV)

And they shall be reborn and breathe again? Where is this Lord when you need him? Surely he must at least be weary of request after request after request. What else do people give him but requests? To fix your heart, he says, call a plumber. He gives you what you need, never what you want.

Photograph of Providence Urgent Care Waiting Room at Noon

Waiting room	Center seat	Back to window
Squeeze my fingers	Under a bitter blanket	Opposite counter
Vertigo	Where?	Merry-go-round stops.
Wall clock running backwards	You seem to have crossed some divide, a distance between following expectations and surprising the reference books on shelves marked Must Remain in Reference Room: No Check Outs – For Scholars Only!	Those were the days of craves Dizzy and Monk and Bird ears. We never worried ears, blood pressure, what gave rise to touch, an orange scarf, blue waterfall behind bridge.
Nurse station	The nurse walks you to the scale, weighs you, takes yr blood pressure, pulse, and temperature. “The doctor will be with you shortly to hear yr confession,” and she leaves you alone to study the posters of the cross sectioned body pinned to the wall.	The doctor knocks and comes in dressed in stole and stethoscope, just like on TV. “I only handle venial issues. Only a specialist can give absolution. But what good is freedom that leads to wild thoughts?”
Waiting Room	Families and individuals. Names called. An ambulance arrives. Para-techs wheel in empty stretcher, disappear into sanctuary. A fire truck appears. Six firemen walk through waiting room like a Rubik’s Cube. Two men in Texas gear waltz across the lobby.	A boy plays with the automatic door. His father. His sister figures it out. A yell and a sigh. A woman crumbles at the nurse’s counter, a Beckett ploy that gets her plenty of attention.
Valet Parking	The sign says No Tips. I hand the parking attendant an Ace which he pockets. Good man!	The drive home.
What the Doctor said	She wanted to see my pocket notebook. “I knew you were dizzy as soon as I laid eyes on you sitting out in the lobby taking pictures of the patients, word pictures.”	In the waiting room waiting continues. Kids run around and play games, laughing. A few people look worried. A couple of folks look hurt, or hurting. A father falls asleep.
The Clinic Closes for the Day	A husband weeps.	A mother changes a dirty diaper.

Micro Poems with Eye Exam

Picnic Technique

Moistly dripping sap
pilly this juicy gusto
pudding wasp crust
paper crisp in cut grass.

Sara Monaurally

The staked sapling at the gibbet

           gallowed

     silent squirming wail.

Fit For a New Hat

When you measured my head
blue eyes saw yonder
sea anemones in tide pools
I wanted to hug you but with
the magnifying tape around my head
ironically did you order
the hat anyway?

Flashing Lights and Floaters

So tiny she climbed up through my nose and into my eyes and swam around
in the vitreous liquid, kicking off my retina.

Such a big name for so tiny a doctor.

“The lights are like paramoeciums falling like electric rain drops
white paisley sparkles on a flat black poster board
down always down never up in the far corner
of the right eye,” she said.

“Yes, I see them,” I said. “There goes one now,
like strobes.”

“It is still somewhat ambiguous,” she said.
“Asymmetrical.”
She had an accent to my ear.
“Let me drop in some dye
and have a swim around.”

High up on the top floor a magnificat view of the streaming
river and tiny cars floaters across the gargantruss
ginormous gargling cement girdles of the fat city.
Straight down where they build the barges
always the two blue cranes shifting
imperceptibly
an orange crane I’d never seen there before.

When she photographed my eyes
I saw faces like on the veil of Veronica
but morphing shapes
and a Trinity:
The father seemed bored, the little kid,
annoyed to be kept waiting,
flitted about like a ghost,
and the mother sat quietly slumped
over in a chair, resting, as if
keeping me company while
the dye spread out my eyes
into two flat brown oceans.

Ending Net Asset Value; or, Hook up, hat up, and let go: “Calling Dr. Bartleby!”

Atul Gawande is a Harvard trained surgeon who writes eloquent prose on health and illness. His New Yorker pieces “Letting Go” and “The Way We Age Now” are full of pathos, ethos, and logos on how and when to die decisions and the bedpan reality of growing old. If he continues his work combining writing, doctoring, and educating, he may some day be up for a Nobel Prize. Gary Becker is a Nobel Prize winning economist and professor at the University of Chicago who writes in his blog, The Becker-Posner Blog, pedestrian prose sometimes infected with either-or fallacies. He shares weekly blog posts with Federal Judge and University of Chicago Law School Professor Richard Posner.

What usually passes for health care in our current reasoning is health care insurance. Those with insurance believe they have health care; those without may think they have neither. And the health care debate is derailed with decisions before legislators that have to do not so much with health care but with health care insurance.

Last Sunday, Becker included in his post what appears to be an economist based claim that includes a formula for calculating the value of a year of life: “Presumably, frail elderly people tend to receive less utility from a year of their current life since their lack of health prevents them from greatly enjoying their leisure time and consumption of different goods. However, the utility cost of any time and money they might spend on prolonging their lives is also lower for them. The fundamental measure of the value of a life year is the ratio of the utility gained to this marginal utility spent on prolonging life. This ratio could even be higher for the old and frail than for healthy younger persons.”

We are becoming increasingly Spartan by the moment, for the reductio ad absurdum of Becker’s argument would have us carrying individuals of any age whose disabilities or frailties preclude utility or whose cost to live outweighs their ability to “enjoy their leisure time and consumption of different goods” out to the rocks to die, as did the Spartans.

“Welcome to the 23^rd Century: The Perfect World of Total Pleasure,” heads the poster for the sci-fi film “Logan’s Run,” which depicts a dome-covered society that eliminates growing old problems by zapping all citizens when they turn the age of 30. The police, called Sandmen, hunt down and kill those who would run from their forced to die moment. Yet there’s a myth, an old story, of life beyond the dome, where people are allowed to grow old. The place where people are allowed to grow old is called Sanctuary.

But there appears to be no Sanctuary for our elderly these days, at least not provided for by Medicare, for there’s simply not enough money to go around, the Becker-Posner argument seems to go, and we should spend what money there is to go around on those able to enjoy life and consume goods. Perhaps enjoying life, in the worldview of the economist, is consuming goods. In any case, the argument has been boiled down to an either-or moment: either we let old people grow old and die sooner than they would with life prolonging health care (including the R&D necessary to develop that care), or we go broke.

But there are other solutions. Yet there is another problem with Becker’s formula: the value of an old person’s life is not necessarily limited to what that person can enjoy or consume; the lives of the elderly may have intrinsic value to others. But not, apparently, to young doctors, for Gawande points out the current dearth of young doctors going into gerontology. There’s a shortage, and there’s no short-term remedy to what will be an ongoing need for specialists to treat the elderly. Gawande’s solution is for every health care practitioner to be versed in basic elderly care issues.

But to be fair to Becker and Posner this week, they do focus on quality of life versus quantity of life and the avoidable invasions of quality by a system not guided by health care concerns but by health care insurance. And Atul Gawande does also question quality versus quantity. What separates Gawande’s argument from Becker-Posner’s is his value of human life expressed in human versus econometric terms. It’s one thing to force someone to die at the age of 30; but is it something else again to force, or even to encourage, that same person to live beyond what most of us, including our ancestors, would recognize as living? Ah, Bartleby! Ah, Doctor!